Health records at great risk of dodgy diagnoses

Dr Richard Fitton cares about the quality of the information he holds about his patients. So do they - some of them were formerly under the care of the late mass murderer Harold Shipman. Fitton has just audited what is in his medical records. The results may be a shock to the £6bn effort to computerise the NHS in England.

Fitton's practice, in Glossopdale, Greater Manchester, was one of the first in the country to allow patients to view their own health records on screen. He has now gone further and encouraged people to check their records at home. In an audit called the Joy Project, after a former patient, patients were sent copies of their records and asked to underline parts they thought were inaccurate and items they wouldn't want to go on to the new shared electronic care records service being set up by the NHS.

Although Fitton's sample was small, the patients taking part were distributed evenly in age and sex. Of 50 who agreed to take part, 31 returned records. Of these, 19 found nothing wrong. However, 10 found one or more errors, mostly transcribing mistakes or poorly captured data.

Some errors were relatively minor: an 11-year-old's date of birth was out by a year, probably because it was transcribed wrongly when the baby was registered. Other patients disagreed with diagnoses of asthma and acne. More seriously, a patient questioned a note about an attempted drug overdose, saying the incident took place 25 years ago.

Five of the 31 identified parts of their notes they wouldn't want shared across the national system. A 17-year-old girl didn't want a request for contraception recorded; a woman felt the same way about a note about dietary advice. Another patient was worried about a note about asthma screening, others about records of mental disorders and pregnancy terminations.

From this (admittedly limited) survey, Fitton estimates that 17 million people in England would challenge their records if they saw them. Of course, the patients in his audit may understandably have been more disposed than the general population to take an interest, and more inclined to return their records if they had something to challenge than if everything was in order.

Even so, this suggests that there is a great deal of dodgy information in the NHS medical records that is now being plugged into the new care records "spine". And records held by GPs may be the best of the bunch. GPs record data on PCs at the "point of care", unlike their hospital colleagues, who tend to enter it later from handwritten notes. Reports from hospitals trying to migrate their old records on to new systems suggest that even basic data such as patients, names and NHS numbers is riddled with errors.

Over the years, patient administration systems - basic systems that record patients' comings and goings - have been modified in all sorts of idiosyncratic ways, with ad hoc data fields set up to capture new pieces of information needed to meet each new Department of Health target.

Some hospitals reckon it will take them on average 15 minutes to cleanse each record so that it can be migrated on to the new shared records. This is basic administrative information - the sensitive clinical information will take longer.

This doesn't mean the cleanup shouldn't be done (it is daft to spend money maintaining inaccurate databases), only that the programme to modernise the NHS's IT should take into account the time and money needed. At the moment, both are in short supply.

And bad information doesn't always come from computers. Earlier this month, a fatal accident inquiry in Scotland found that 62-year-old Moira Pullar died at Monklands general hospital after being given 10 times too much insulin. A decimal point error in the software? Not so: a nurse misread the writing on a patient chart and failed to follow the proper procedure of checking with another nurse.

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